Making performance indicators work Studies exploring the actionability of healthcare performance indicators applied to primary health care and COVID-19 decision-making

As healthcare systems become more data-rich and technology-enabled, the importance to harness this potential or risk the consequences of performance measurement that fails to add value, has put a spotlight on the use of healthcare performance indicators that are actionable. Despite the clarity with which actionability has been prioritised, its conceptualisation, and how it can be translated into practice within and across healthcare systems, still remains ambiguous. This thesis was guided by the overarching aim to explore actionability and its constructs of fitness for purpose and fitness for use both conceptually and in practice. In Part I, a more nuanced understanding of fitness for purpose and use is pursued. Parts II and Parts III investigate real-world applications of healthcare performance indicators in the context of primary health care (PHC) and the COVID-19 pandemic. The results of this research highlight a range of resources for strengthening actionability, including a framework for measuring PHC across countries, considerations for using different primary care data sources, features for optimising dashboards, and lessons about the process of dashboard development that could apply both in a pandemic context and beyond. Ultimately, the findings call for the continued prioritisation of measurement, governance and management, and the use of measurement in practice, for performance indicators that work.